Provider Demographics
NPI:1679989065
Name:SEXABILITY LLC
Entity type:Organization
Organization Name:SEXABILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:763-229-8508
Mailing Address - Street 1:1121 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8952
Mailing Address - Country:US
Mailing Address - Phone:763-229-8508
Mailing Address - Fax:
Practice Address - Street 1:11670 FOUNTAINS DR
Practice Address - Street 2:200
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7195
Practice Address - Country:US
Practice Address - Phone:763-229-8508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR11529-5261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1669489951Medicare PIN